Schatz highlights the current limitations to a broader integration of T1D screening and suggests methods to circumvent these blockages.
Early, population-level screening for
In a recent perspective piece in Pediatrics Open Science, Desmond Schatz, MD, professor and medical director of the Diabetes Institute and director of the Clinical Research Center in the CTSI at the University of Florida, highlights the critical importance of early and frequent T1D screening, given the volume of patients potentially at risk of developing the disease.1
“1 in 20 relatives of patients with type 1 diabetes are at risk of developing the disease,” Schatz told HCPLive in an exclusive interview. “It’s really important that we can screen. We have the tools available, we’ve learned a lot about the natural history of the disease, and as such, we can offer screening to really all relatives of patients with type 1 diabetes, as well as those who are at risk.”
The American Diabetes Association (ADA) released an updated version of its Standards of Care in Diabetes in 2026, expanding on a 2025 recommendation for autoantibody-based screenings in at-risk individuals. The updated document further expands on this procedure, with an emphasis on family history of T1D or known elevated genetic risk as a red flag for clinicians.2
The guidelines recommend that screening should be offered to any of these patients, but actual data reflect that ≤90% of cases have no established familial connection. Schatz and colleagues suggest that clinicians maintain a “high index of suspicion” for T1D. The team suggests, based on existing analyses, that population-based screening, rather than symptom-based, could increase the number of children diagnosed by roughly 60%. These initiatives have been implemented in the UK and Italy, although broader implementation is held back by multiple uncertainties.1,2
Schatz and colleagues highlight the critical need for educational initiatives, given that many have insufficient knowledge of the disease and its potential complications. Another study showed that 16% of individuals diagnosed with T1D before the age of 18 were initially diagnosed with a different condition – this misdiagnosis was then associated with an 18% increased risk of diabetic ketoacidosis (DKA).1
Additionally, gaps in training are reflected in the clinic – T1D screening has not been widely integrated into medical education. Schatz highlights the need for hands-on training, informational guides, interactive case-based activities, and so on to alleviate this shortcoming.1
Another key shortcoming in T1D testing flagged by the team is a lack of familiarity with the available options, resulting in substantial inertia. Schatz and colleagues stated that primary care clinicians should be made aware of available autoantibody screenings so that they can ensure patients receive accurate and on-time screenings before symptoms manifest.1
Ultimately, Schatz and colleagues emphasize the need for enhanced training, education, and awareness around both the need for T1D screening and the various organizations that can provide it to patients. They encourage primary care physicians and pediatricians to discuss T1D risk with patients and families, emphasizing the need for attentive monitoring and early screening.1
“You’ve got to get to know the family,” Schatz said. “You’ve got to understand that each family is very different, and you have to work on establishing a relationship with a family. It’s a very detailed discussion, and at this point in time it should only be done in specialized centers because, even if they did have the time, I think pediatricians are not educated enough to know the nuances of the disease.”
Editors’ Note: Schatz reports serving on the board of the Diabetes Leadership Council.
